• Clinical Pain
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• v.20 no.1
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• pp.39-42
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• 2021

A 29-year-old woman had 1-month history of back pain radiating into lower extremities, motor weakness, and sensory abnormalities in both lower extremities. Contrast-enhanced spinal magnetic resonance imaging (MRI) revealed a homogeneously enhancing mass at the T12~L1 and several intradural enhancing nodular lesions at L2~S1. Tumor resection surgery was performed and following histological examination showed that the tumor satisfied the diagnostic criteria for atypical choroid plexus papilloma (CPP). To find primary tumor sites, contrast-enhanced brain MRI, whole spine MRI, and PET-CT were carried out and additional lesions were detected at the fourth ventricle, right cerebellum, and upper thoracic spinal cord. This is a very rare case of metastatic atypical CPP that involves brain, upper thoracic spinal cord, and cauda equina with initial manifestation of radicular symptoms without clinical signs of primary brain lesion.

• The Korean Journal of Pain
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• v.36 no.2
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• pp.184-194
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• 2023

Background: Degenerative lumbar spondylolisthesis (DLS) is frequently associated with lumbar spinal stenosis (LSS) and conservative treatments such as epidural steroid injection do not have long-term benefits in LSS patients with DLS. This study evaluated the effectiveness of percutaneous epidural neuroplasty using a balloon catheter in patients with LSS and DLS. Methods: Patients' sex, age, body mass index, diabetes, hypertension, stenosis grading, pain duration, location, pain intensity, and medications were retrieved from electronic medical records. At 1, 3, and 6 months following the procedure, data on pain severity, medication usage, and physical functional status were analyzed. A generalized estimating equations model was used at the six-month follow-up. Patients were divided into those with DLS (the spondylolisthesis group) and those without DLS (the no spondylolisthesis group) to evaluate whether the effects of percutaneous epidural neuroplasty using a balloon catheter were different. Results: A total of 826 patients were included (spondylolisthesis: 433 patients, 52.4%; no spondylolisthesis: 393 patients, 47.6%). Age, body mass index, hypertension, pain location, and stenosis grading were statistically different between the two groups. The generalized estimating equations analyses with unadjusted and adjusted estimation revealed a significant improvement in the estimated mean numerical rating scale of pain intensities compared to that at baseline in both groups (P < 0.001). Any adverse events that occurred were minor and temporary. Conclusions: Percutaneous epidural neuroplasty using a balloon catheter may be an alternative treatment option for patients with chronic LSS, regardless of accompanying DLS, who have had failed conservative management.

• The Korean Journal of Pain
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• v.33 no.2
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• pp.97-98
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• 2020

• The Korean Journal of Pain
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• v.14 no.2
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• pp.249-252
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• 2001

Total spinal anesthesia is a serious life threatening complication of spinal and epidural anesthesia. We report an accidental total spinal anesthesia developed during a thoracic epidural block in a practitioner's pain clinic. A 69-year-old female with post-herpetic neuralgia was treated by a thoracic epidural block. A thoracic tapping for the epidural block was performed in the right lateral position at a level between $T_{5-6}$, using a 23 gauge Tuohy needle. After the epidural space was identified, a mixed solution of 10 ml of 0.3% lidocaine and 20 mg of triamcinolone was injected into the epidural space. After removal of the syringe, fluid was dripping through the needle. The patient subsequently complained of dyspnea and dizziness, and she became unconscious. She was intubated immediately and cardiopulmonary resuscitation was performed because there was no pulse palpable. The patient recovered an hour after transfer to a general hospital and was discharged without any further complication 19 days later.

• Journal of Korean Medicine Rehabilitation
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• v.30 no.1
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• pp.125-135
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• 2020

To report the effect of an Korean medical treatment, including Space spinal conduction exercise and manipulation treatment for a patient suffering with spondylolisthesis. Three patients were treated by oriental medical treatment including acupuncture, oriental medicine, Space spinal conduction exercise and manipulation treatment and the results were assessed with a numerical rating scale (NRS), walking condition, and back pain, sciatica. After treatment, the NRS changed from 8~9 to 1~2 and walking condition get better. The patient's back pain and sciatica have improved. In this study, oriental medical treatment, including Space spinal conduction exercise and manipulation treatment was an effective treatment for patients with spondylolisthesis. However, additional studies are needed, as are more and observations of these patients.

• The Korean Journal of Pain
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• v.8 no.2
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• pp.390-393
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• 1995

Although spinal anesthesia has long been considered a safe technique, it is not without risk or side effect. Cauda equina syndrome is a rare but serious complication of spinal anesthesia. We have experience a case of cauda equina syndrome after spinal anesthesia. A twenty year old healthy male patient complained of pain, numbness, tingling sensation and motor weakness on his right lower extremity 8 hours after subarachnoid blockade. On the following day, the patient was noted to have a right L1 to S2 radiculopathy. Magnetic Resonance Imaging results were unremarkable. The patient sprained his ankle while trying to move down from the bed, so short leg splint was applied. Then he had additional right common peroneal nerve injury from the splint. His neurologic symptoms improved gradually thereafter, and three months postoperatively his electromyogram revealed improving stage from right common peroneal nerve palsy.

• Journal of Korean Medical Ki-Gong Academy
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• v.19 no.1
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• pp.99-115
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• 2019

Introduction : In patient with ankylosing spondylitis, when bone formation progresses, spinal fusion occurs and joint motion is severely limited. We performed Medical Gi-gong and Korean medical therapies in patient with advanced ankylosing spondylitis with spinal fusion. Case : 46-year-old male with extensive spinal fusion at the cervical and lumbar spine complains of back pain, hip pain, joint stiffness, eye pain, and digestive problems. HLA-B27 (+), mSASSS is 70. Medical Gi-gong was done 311 days for 340 days. Acupuncture, cupping, and manual treatment were performed once every 5.9 days for one year. BASDAI improved from 5.3 to 4.3, BASFI from 4.3 to 3.7, and BASMI from 6.8 to 5.8. mSASSS did not change. Conclusions : Patients with advanced ankylosing spondylitis were treated with Medical Gigong and Korean medical therapies to achieve a slight improvement.

• The Korean Journal of Pain
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• v.20 no.2
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• pp.138-142
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• 2007

Background: Depression is a frequent comorbid disease of chronic pain patients. This study was conducted to evaluate the prevalence of depression and to correlate associated factors and depression in patients with lumbar spinal stenosis. Methods: The data of this survey was collected from 97 patients that visited our pain clinic for the management of lumbar spinal stenosis. Depression was examined by a self-reported survey using the Korean version of the Beck Depression Inventory (BDI). The Oswestry Disability Index (ODI) and the life satisfaction scale score were also obtained. Demographic and clinical characteristics (including spouse status, employment status, smoking status, the number of patients with multiple painful areas, the number of patients with combined disease, pain duration, visual analogue scale, Roland 5-point scale and walking distance) were obtained from an interview with the patient. The patients were divided into group N ($BDI{\leq}14$, n = 43) and group 0 (BDI > 14, n = 54) according to the BDI scale. Of the 97 patients, 55,7% had a high BDI score. Results: The patients in group N had a higher rate of employment (48.0%, P < 0.05) and had higher life satisfaction scale scores ($9.4{\pm}2.5$, P < 0.01) as compared to group D patients. The BDI score showed a close correlation with employment status and the life satisfaction scale. Conclusions: Many lumbar spinal stenosis patients had high BDI scores. Employment status and the life satisfaction scale were closely correlated with the BDI score.

• The Korean Journal of Pain
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• v.34 no.1
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• pp.58-65
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• 2021

Background: Supraspinal delivery of neurotensin (NTS), which may contribute to the effect of a systemically administered agonist, has been reported to be either pronociceptive or antinociceptive. Here, we evaluated the effects of systemically administered NTSR1 agonist in a rat model of neuropathic pain and elucidated the underlying supraspinal mechanism. Methods: Neuropathic pain was induced by L5 and L6 spinal nerve ligation in male Sprague-Dawley rats. The effects of intraperitoneally administered NTSR1 agonist PD 149163 was assessed using von Frey filaments. To examine the role of 5-HT neurotransmission, a serotonin (5-HT) receptor antagonist dihydroergocristine was pretreated intrathecally, and spinal microdialysis studies were performed to measure the change in extracellular level of 5-HT in response to PD 149163 administration. To investigate the supraspinal mechanism, NTSR1 antagonist 48692 was microinjected into the rostral ventromedial medulla (RVM) prior to systemic PD 149163. Additionally, the effect of intrathecal DHE on intra-RVM PD 149163 was assessed. Results: Intraperitoneally administered PD 149163 exhibited a dose-dependent attenuation of mechanical allodynia. This effect was partially reversed by intrathecal pretreatment with dihydroergocristine and was accompanied by an increased extracellular level of 5-HT in the spinal cord. The PD 149163-produced antinociception was also blocked by intra-RVM SB 48692. Direct injection of PD 149163 into the RVM mimicked the maximum effect of the same drug delivered intraperitoneally, which was reversed by intrathecal dihydroergocristine. Conclusions: These observations indicate that systemically administered NTSR1 agonist produces antinociception through the NTSR1 in the RVM, activating descending serotonergic projection to release 5-HT into the spinal dorsal horn.

• Journal of Hospice and Palliative Care
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• v.12 no.2
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• pp.88-94
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• 2009

Chest pain is a symptom observed commonly in outpatients and emergency room patients, and its causes are variable. Because treatment and prognosis of chest pain are different depending on its cause, it is more important than anything else to accurately diagnose the cause of chest pain. Most of patients complaining of chest pain undergo basic tests at a private local clinic or at the Internal medicine or chest surgery department of a general hospital and, they are referred to the pain clinic, with a note stating no particular finding. However, if they have sustained severe neuropathic pain in spite of nerve block, accurate diagnosis for chest pain is essential. We experienced rapidly developing spine breakdown and cord compression caused by metastatic spinal tumor in an inpatient who was being treated for chest pain, and thus, we report here in the case with literature review.